Cluster randomised trial of intermittent preventive treatment for malaria in infants in area of high, seasonal transmission in Ghana

Re: Cluster randomised trial of intermittent preventive treatment for malaria in infants in area of high, seasonal transmission in Ghana

Repeated episodes of malaria are common in young children in West Africa. During the transmission season for malaria, cases are much more common. In areas where this is the case, drugs can be given at regular intervals throughout the transmission season, regardless of whether a child has malaria symptoms or not.

The evidence in this paper concludes that IPT reduces the risk of developing malaria in infants living in endemic areas with seasonal transmission. There is good evidence from a number of trials that giving antimalarial drugs in this way is an effective policy option (it reduces the number of cases of malaria). The precise drug and dose which offers the largest benefit is not entirely clear and should be based on factors such as local resistance patterns.

Despite this, the primary concern is that there are no long-term trials examining the developmental effects of these antimalarial drugs or their long-term efficacy. Whilst IPTc may offer considerable advantages in infants, parents should be informed about the lack of long-term evidence for various factors including the development of drug resistance and interference with the development of naturally-acquired immunity. Caution should be applied as there is a possibility that IPC increases a child's vulnerability to severe malaria when they grow older.

Detection of malaria in participants in this trial was through a passive surveillance system, which relies on parents bringing their child to a study health centre. This is a potential weakness since not all affected children may present to the study health centres for a variety of reasons. If this occurs differentially in the two study arms, the effectiveness of the intervention may be over/under-estimated. No evidence on cost-effectiveness is presented. This makes it difficult to make a full comparison with other existing prevention and treatment strategies.